The Faculty of Public Health (FPH) is exploring the potential of credentialing, as a means of making careers in public health more flexible and strengthening governance. The General Medical Council (GMC) defines credentialing as: “a process which provides formal accreditation of competences (which include knowledge, skills and performance) in a defined area of practice, at a level that provides confidence that the individual is fit to practise in that area…”

The work is overseen by FPH’s Education Standing Committee. In 2017 a task and finish group, under the able leadership of David Chappel, was set up to explore the background to credentialing and how it might benefit public health. Credentialing has also been raised as a potentially important development by Fit for the Future, The Shape of Training report, Health of the Public 2040, and Facing the Facts.

FPH, supported by Public Health England, held a workshop on 8 February 2018 to bring together interested parties to discuss what the benefits of developing public health credentials might be and what we need to do next to develop them. Thirty-eight individuals attended the workshop.

There was widespread discussion both in small groups and plenary about both ‘post completion of speciality training credentials’ in fields such as health protection as well as a ‘public health credential’ for groups outside the core workforce doing public health work. FPH has a potential role as a ‘credentialing body’ which develops and awards a credential.

I have a number of personal reflections on what I heard on the day. The small groups all independently came up with a very consistent common message on credentialing after completion of speciality training. Speciality training is part of a process of lifelong learning, and mechanisms that already exist, such as continuing professional development and revalidation appraisal, are sufficient to ensure appropriate development in a consultant post. The curriculum is facilitative and its implementation in the delivery of training should prepare specialists for appointment to their first consultant posts. Consultants will then develop their professional knowledge and skills throughout their subsequent career.

A second common theme from participants was questioning the need for a specialist-level credential that covered part of the curriculum. For me these concerns were consistent with the FPH position that all specialists should demonstrate competence across the whole of the current curriculum at the point of specialist registration. There is a danger that such credentials would simply reinvent ‘defined specialists’.

The development of the wider public health workforce was seen as an important objective. The question for me that arose from these discussions was the form of this development: should it be a ‘regulated credential’, a ‘credential’ or some form of ‘certificate’ in public health.

Credentialing is a complex area. Credentials could take many forms and are a proposed solution for many real and perceived problems. Credentials may not always be the most effective or efficient way to address these problems. When a credential is an appropriate solution its development and implementation will require a partnership between a number of organisations. A credentialing body, such as FPH is necessary but not sufficient. A credential will need to be commissioned (funded) and the necessary training delivered by an educational provider.

Public health is proudly an evidence-based field. But evidence without values cannot tell us what we should do.

We need public health ethics if we are to understand and explain, by reference to the classic definition of public health advanced by Winslow, what we, as a society, ought to do to assure the conditions in which people can enjoy good health and equitable prospects for health. Using the ‘organised efforts of society’ to protect and promote health and wellbeing is an ethical goal – indeed, as many of us would argue, it is an ethical imperative. And to be achieved, it requires law and policy. To evaluate when threats to health warrant a public health response, scientific analyses must be complemented by matters such as the balancing of values, an assessment of the relative merits of different possible interventions, an appreciation of the likely risks and impacts of intervening, and a sensitivity to political and cultural contexts and realities.

At a workshop convened in London, at the Royal College of Physicians on 18 January 2018, public health practitioners, trainees, leaders, researchers and policy-makers joined with scholars in public health ethics to discuss how public health ethics and law (PHEL) might be established as a professional competency, and how we might ensure that it is robust and rigorous through education and training. This is part of a project I am involved in with AM Viens at the University of Southampton, and Farhang Tahzib, Chair of the Faculty of Public Health (FPH)’s ethics committee and a champion for bringing academic public health ethics into practice.

We argue that the public health workforce needs a clearly defined PHEL competency, secured within public health education and ongoing professional training. This builds on further work that we have done regarding PHEL expertise to support the Public Health Skills and Knowledge Framework. As contributions throughout the day affirmed, such a competency requires to be explained in a way that is academically robust: is it based on sound and coherent principles? It must be practically realisable: is it clear how to apply the PHEL competency in the vast, complex, and challenging range of practical situations covered by public health? And it must be treated properly as an essential part of public health capacity: how, for example, can we ensure it is taken seriously as part of continuing professional development requirements? The feedback and engaged discussion from all participants were complemented and further stimulated by contributions from Bruce Jennings – described by Farhang as one of the fathers of public health ethics – as well as an expert panel on which Bruce was joined by Angus Dawson, Vikki Entwistle, Kevin Fenton and Fiona Sim.

Just as areas such as statistical analysis and detection of disease require skills and expertise, so do legal and ethical understanding and practice. As FPH President John Middleton suggested at the start of the day, we need to consider how questions of justice impact public health practice, and how our overall political agendas should be shaped if we are to achieve a sustainably fairer society. For good practice, and good frameworks for practice, PHEL experts need to work with the public health community to ensure that ethical challenges, big and small, can be addressed with proper knowledge, understanding, and skills in ethical, legal, and political reasoning.

We look forward to publishing a full report on our findings, detailing how the PHEL competency should be defined, and a range of model materials for PHEL education and training through FPH’s website, as well as wider academic papers. It is an exciting time to be engaging with FPH and other partners to advance these agendas, strengthening capacity for ethics and law in public health.

Disclaimer

The aim of this blog is to encourage discussion and debate on public health issues. The views expressed here are the personal views of authors, and the content does not reflect the official position of the Faculty of Public Health. However, discussion generated here may be used to influence the development of organisational policy.